Drug-resistant MRSA bacteria – here to stay in both hospital and community (PLoS Pathogens)

A colorized scanning electron micrograph of a white blood cell eating an antibiotic resistant strain of Staphylococcus aureus bacteria, commonly known as MRSA. (Source: National Institute of Allergy and Infectious Diseases (NIAID))

The drug-resistant bacteria known as MRSA, once confined to hospitals but now widespread in communities, will likely continue to exist in both settings as separate strains, according to a new study.

The prediction that both strains will coexist is reassuring because previous projections indicated that the more invasive and fast-growing community strains would overtake and eliminate hospital strains, possibly posing a threat to public health.

Researchers at Princeton University used mathematical models to explore what will happen to community and hospital MRSA strains, which differ genetically. Originally MRSA, which is short for methicillin-resistant Staphylococcus aureus, was confined to hospitals. However, community-associated strains emerged in the past decade and can spread widely from person to person in schools, athletic facilities and homes.

Both community and hospital strains cause diseases ranging from skin and soft-tissue infections to pneumonia and septicemia. Hospital MRSA is resistant to numerous antibiotics and is very difficult to treat, while community MRSA is resistant to fewer antibiotics.

The new study found that these differences in antibiotic resistance, combined with more aggressive antibiotic usage patterns in hospitals versus the community setting, over time will permit hospital strains to survive despite the competition from community strains. Hospital-based antibiotic usage is likely to successfully treat patients infected with community strains, preventing the newcomer strains from spreading to new patients and gaining the foothold they need to out-compete the hospital strains.

The researchers made their predictions by using mathematical models of MRSA transmission that take into account data on drug-usage, resistance profiles, person-to-person contact, and patient age.

Published February 28 in the journal PLOS Pathogens, the study was conducted by postdoctoral researcher Roger Kouyos, now a scholar at the University of Zurich, and Eili Klein, a graduate student who is now an assistant professor in the Johns Hopkins School of Medicine. They conducted the work under the advisement of Bryan Grenfell, Princeton’s Kathryn Briger and Sarah Fenton Professor of Ecology and Evolutionary Biology and Public Affairs at Princeton’s Woodrow Wilson School of International and Public Affairs.

RK was supported by the Swiss National Science Foundation (Grants PA00P3_131498 and PZ00P3_142411). EK was supported by Princeton University (Harold W. Dodds Fellowship), as well as the Models of Infectious Disease Agent Study (MIDAS), under Award Number U01GM070708 from the National Institute of General Medical Sciences. BG was supported by the Bill and Melinda Gates Foundation; the Research and Policy for Infectious Disease Dynamics (RAPIDD) program of the Science and Technology Directorate, Department of Homeland Security; and the Fogarty International Center, National Institutes of Health.